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TPI is used to treat extremely painful areas of muscle. Normal muscle contracts and relaxes when it is active. A trigger point is a knot or tight, ropy band of muscle that forms when muscle fails to relax. The knot often can be felt under the skin and may twitch involuntarily then touched (called a jump sign) The trigger point can trap or irritate surrounding nerves and cause referred pain- pain felt in another part of the body. Scar tissue, loss of range of motion, and weakness may develop over time. TPI is used to alleviate myofascial pain syndrome (chronic pain involving tissue that surrounds muscle) that does not respond to other treatment, although there is some debate over its effectiveness. Many muscle groups, especially those in the arms, legs, lower back, and neck, are treated by this method. TPI also can be used to treat fibromyalgia and tension headaches.

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​Epidural steroid injections provide diagnostic data and pain relief by delivering local anesthetic and anti-inflammatory steroid medications into the spinal area on the surface of the spinal column. This procedure may reduce inflammation, resulting in long-term pain relief, and provides valuable information on the source of your pain.You will be situated on your stomach or on your side, on a table in the fluoroscopic room and made to feel as comfortable as possible. The doctor will identify where the injection should be given and will sterilize the skin with an antiseptic solution. He or she will then inject a local anesthetic to help numb the area before administering the epidural injection. Once the area is numb, the doctor will use imaging guidance to help guide the epidural needle to exactly the right position. When the needle is in place, a contrast material will be injected so the doctor can ensure the distribution of the medication given. Then, your doctor will slowly inject the medication, which is typically a combination of anesthetic and anti-inflammatory drugs (cortisone/steroids). When finished, you will be moved into a chair orbed and allowed to rest for a few minutes to an hour. The nurse will make sure you do not have any unfavorable reactions to the medication before you are allowed to leave.

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Pain Management Services:

Facet Injections Myelograms
Trigger Point Injections Arthograms
Epidural Steroid Injections
Nerve Block
Spinal Cord Stimulator Trials
Knee, Shoulder, & Hip Injections for pain/bursitis ​

Our Docs will help you decide which treatment is best for your pain type.



Facet joints are small joints at each segment of the spine that provide stability and help guide motion. The facet joints can become painful due to arthritis of the spine, a back injury or mechanical stress to the back. A cervical (neck), thoracic (upper back) or lumbar (lower back) facet joint injection involves injecting a steroid local anesthetic mixture, which can anesthetize the facet joints and block the pain. Facet joint injections usually have two goals: to help diagnose the cause and location of pain and also to provide pain relief.

Diagnostic goals: By placing numbing medicine into the joint, the amount of immediate pain relief experienced by the patient will help confirm or deny the joint as a source of pain. If complete pain relief is achieved while some of the facet joints are numb it means those joints are likely to be the source of pain.
The pain relief from a facet injection is intended to help a patient better tolerate a physical therapy routine to rehabilitate his or her injury or back condition and to diagnose the source of pain.

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The goal of a facet rhizotomy, either a cervical facet rhizotomy or lumbar facet rhizotomy, is to provide pain relief by "shutting off" the pain signals that the joints send to the brain. The pain relief experienced by most patients who have this procedure lasts months or even years.

Patients who are candidates for rhizotomy typically have undergone several facet joint injections to verify the source and exact location of their pain. Using a local anesthetic and x-ray guidance, a needle with an electrode at the tip is placed alongside the small nerves to the facet joint. The electrode is then heated, with a technology called radiofrequency, to deaden these nerves that carry pain signals to the brain. The procedure takes about 30-60 minutes. Afterwards, patients are monitored for a short time before being released.

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​​Regional nerve blockade, or more commonly nerve block, is a general term used to refer to the injection of local anesthetic onto or near nerves for temporary control of pain. It can also be used as a diagnostic tool to identify specific nerves as pain generators. Permanent nerve block can be produced by destruction of nerve tissue.

Nerve blocks usually take only minutes to administer.
You will be positioned on a table or other surface to allow the doctor access to the site(s) to be injected. The doctor will then identify the spot the needle needs to be placed, using palpation and/or imaging guidance. He or she will clean the area with antiseptic solution, and then the needle will be inserted at a specific depth to deliver the medication as close to the problematic nerve(s) as possible.
More than one injection may be required, depending on how many areas of pain you have or how large an area needs to be covered. The doctor will most likely tell you when he or she inserts the needle and when the injection is done. When finished, you will be allowed to rest for 15 to 30 minutes to let the medication take effect. The nurse will also make sure you don't have any unexpected side effects before you leave the doctor's office.

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A spinal cord stimulator is a device used to exert pulsed electrical signals to the spinal cord to control chronic pain. Further applications is in motor disorders.Spinal cord stimulators are most often used for patients with chronic and severe neuropathic pain, who have not responded to other more conservative treatments. Neuropathic pain is pain due to damaged nerve tissue. Common examples include patients with post-laminectomy nerve damage, radiculopathy, diabetic neuropathy and reflex sympathetic dystrophy.

Here is how procedure is done:

The patient is monitored with an EKG, blood pressure cuff and an oxygen-monitoring device. The procedure is performed under sterile conditions. In a spinal cord stimulator trial, temporary electrodes are placed and then the patient uses an external device to generate electrical current. The electrodes are placed under x-ray guidance with the patient lying on his belly. A local anesthetic is used to numb the skin and deeper tissues. An introducer needle is passed into the epidural space. The electrodes are inserted through the introducer needle. The position of the spinal cord stimulator electrodes is adjusted until stimulation covers as much of the painful area as possible. When this is accomplished, the introducer needle is removed and the temporary wire is secured to the skin with a small stitch and a large sticky bandage.

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